Surgical Repair of Perforated Peptic Ulcers: Laparoscopic vs. Open Approach

University of Minnesota M.S. thesis.January 2019. Major: Clinical Research. Advisor: James Harmon. 1 computer file (PDF); v, 26 pages.Perforated peptic ulcers are a surgical emergency that can be repaired using either laparoscopic surgery (LS) or open surgery (OS). No consensus has been reached on the comparative outcomes and safety of each approach. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, we conducted a 12-year retrospective review (2005 - 2016) and identified 6,260 adult patients who underwent either LS (n = 616) or OS (n = 5,644) to repair perforated peptic ulcers. To mitigate selection bias and adjust for the inherent heterogeneity between groups, we used propensity-score matching with a case (LS):control (OS) ratio of 1:3. We then compared intraoperative outcomes such as operative time, and 30-day postoperative outcomes including infectious and non-infectious complications, and mortality. Propensity-score matching created a total of 2,462 matched pairs (616 in the LS group, 1,846 in the OS group). Univariate analysis demonstrated successful matching of patient characteristics and baseline clinical variables. We found that OS was associated with a shorter operative time (67.0 ± 28.6 minutes, OS vs. 86.9 ± 57.5 minutes, LS; P < 0.001) but a longer hospital stay (8.6 ± 6.2 days, OS vs. 7.8 ± 5.9 days, LS; P = 0.001). LS was associated with a lower rate of superficial surgical site infections (1.5%, LS vs. 4.2%, OS; P = 0.032), wound dehiscence (0.3%, LS vs. 1.6%, OS; P = 0.030), and mortality (3.2%, LS vs. 5.4%, OS; P = 0.009). Fewer than 10% of patients with perforated peptic ulcers underwent LS, which was associated with reduced length of stay, lower rate of superficial surgical site infections, wound dehiscence, and mortality. Given our results, a greater emphasis should be provided to a minimally invasive approach for the surgical repair of perforated peptic ulcers